Surgical management of cervical paragangliomas

Carotid body tumors are rare, but represent the most common form of head and neck paraganglioma. We present 17 surgically treated patients. The present study reviews our experience in the diagnosis and treatment of these uncommon lesions. At surgery, 11 tumors were classified as Shamblin Class II and six as Class III. A cerebral angiogram was obtained in all cases before surgery. A cervical approach was the method of choice in 16 cases; in one case with mediastinal extension of the tumor we used a combined cervical and transsternal approach. Complete excision of the tumor was accomplished in all cases. Subadventitial tumor excision was performed in eight cases whereas internal carotid artery reconstruction was obtained in eight cases (three saphenous interposition vein grafts, two polytetrafluoroethylene (PTFE) 6 mm grafts, and end-to-end anastomosis in three cases). Resection of the left common carotid artery and reconstruction with a Dacron 8 mm graft was performed in the case with mediastinal tumor extension. Duplex scan along with angiography is effective in making the diagnosis. Excision is indicated for most tumors, and best results are achieved by an experienced vascular surgeon.